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Dobronravov V.A.

Research Institute of Nephrology, I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of the Russian Federation, Saint Petersburg, Russia

Mayer D.A.

I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, Saint Petersburg, Russia

Berezhnaya O.V.

I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, Saint Petersburg, Russia

Lapin S.V.

Pavlov First St. Petersburg State Medical University, Russia, 197022, St. Petersburg, St. Leo Tolstoy 6/8

Mazing A.V.

First Saint-Petersburg Pavlov State Medical University, Saint-Petersburg

Sipovskiĭ V.G.

Nauchno-issledovatel'skiĭ institut nefrologii GBOU VPO "Sankt-Peterburgskiĭ gosudarstvennyĭ meditsinskiĭ universitet im. akad. I.P. Pavlova"

Smirnov A.V.

Volgograd State Medical University, Volgograd, Russia

Membranous nephropathy in a Russian population

Authors:

Dobronravov V.A., Mayer D.A., Berezhnaya O.V., Lapin S.V., Mazing A.V., Sipovskiĭ V.G., Smirnov A.V.

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Journal: Therapeutic Archive. 2017;89(6): 21‑29

DOI: 10.17116/terarkh201789621-29

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Table of contents

MEMBRANOUS NEPHROPATHY IN A RUSSIAN POPULATION
MEMBRANOUS NEPHROPATHY IN A RUSSIAN POPULATION

To cite this article:

Dobronravov VA, Mayer DA, Berezhnaya OV, Lapin SV, Mazing AV, Sipovskiĭ VG, Smirnov AV. Membranous nephropathy in a Russian population. Therapeutic Archive. 2017;89(6):21‑29. (In Russ.)
https://doi.org/10.17116/terarkh201789621-29

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Abstract:

Aim. To analyze the clinical and morphological manifestations of membranous nephropathy (MN) and to evaluate the efficiency of its therapy. Materials and methods. MN cases in 2009 to 2016 were retrospectively detected with a subsequent analysis of patients with primary MN (PMN). The titer of IgG-autoantibodies to phospholipase A2 receptor (anti-PLA2R Ab) was determined by an indirect immunofluorescence assay. Treatment outcomes, such as the time course of changes in proteinuria, nephrotic syndrome (NS), and the development of complete and partial remissions (CR and PR), were assessed. Results. MN was detected in 201 cases; the secondary etiology of the disease was established in 24.9%. The prevalence of MN among morphologically confirmed glomerulopathies was 14%; that of PMN was 10.4%. The median period to diagnosis PMN was 8 (5; 19) months. 150 patients with PMN (66.7% were men; age was 50±15 years) were distributed according to the following morphological stages: Stages I (23.9%), II (48.5%), III (26.1%), and IV (1.5%). Elevated anti-PLA2R Ab levels were found in 51.6% of cases; NS in the presence of proteinuria was detected in 85.6% of patients. An estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73 m2 was seen in 25% of cases. Treatment outcomes were evaluated in 80 cases; the median follow-up period was 19 (8; 40) months. 68% of cases had CR (32%) or PR (36%) with a median follow-up of 26 (13; 44) months. Spontaneous CRs or PRs were observed in 7.5% of the patients. Multivariate analysis showed that the probability of CR or PR increased 3.2-fold in the use of cyclophosphamide and/or cyclosporine and decreased as eGFR dropped. Conclusion. In Russia, PMN is a common type of glomerulopathy, the specific features of which should include the low rates of spontaneous remissions and detection of anti-PLA2R Abs. For renal protection, the majority of patients with PMN require timely diagnosis and treatment; individualization of the choice of treatment and its enhanced efficiency call for further investigations.

Keywords:

primary membranous nephropathy
anti-PLA2R antibodies
glucocorticosteroids
cyclosporine
cyclophosphamide
spontaneous remission
complete remission
partial remission

Authors:

Dobronravov V.A.

Research Institute of Nephrology, I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of the Russian Federation, Saint Petersburg, Russia

Mayer D.A.

I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, Saint Petersburg, Russia

Berezhnaya O.V.

I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, Saint Petersburg, Russia

Lapin S.V.

Pavlov First St. Petersburg State Medical University, Russia, 197022, St. Petersburg, St. Leo Tolstoy 6/8

Mazing A.V.

First Saint-Petersburg Pavlov State Medical University, Saint-Petersburg

Sipovskiĭ V.G.

Nauchno-issledovatel'skiĭ institut nefrologii GBOU VPO "Sankt-Peterburgskiĭ gosudarstvennyĭ meditsinskiĭ universitet im. akad. I.P. Pavlova"

Smirnov A.V.

Volgograd State Medical University, Volgograd, Russia

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